STD Screening of HIV-Infected MSM in HIV Clinics

National guidelines recommend asymptomatic routine STD screening for HIV-positive patients. The researchers undertook the current study to learn whether these guidelines are being followed by providers caring for HIV-positive men who have sex with men.

By abstracting medical records at eight large HIV clinics in six US cities, the authors estimated the number of men who underwent at least one test for syphilis, chlamydia (urethral and/or rectal), or gonorrhea (urethral, rectal and/or pharyngeal) in 2004, 2005, and 2006. Nucleic acid amplification testing of both urethral swabs and urine was included in the urethral testing. The researchers further calculated the positivity for syphilis, chlamydia, and gonorrhea among the men who were screened.

The medical records of 1,334 HIV-positive MSM making 14,659 clinic visits from 2004 to 2006 were abstracted. During this period, the annual screening rate for syphilis ranged from 66 percent to 75.8 percent. Despite moderate to high positivity of specimens from asymptomatic patients (3 percent to 9.8 percent), annual screening rates for rectal chlamydia and rectal and pharyngeal gonorrhea ranged from 2.3 percent to 8.5 percent. Annual urethral chlamydia and gonorrhea screening rates of 13.8 percent to 18.3 percent were higher than rates for nonurethral sites but were still suboptimal.

"Most asymptomatic HIV-infected MSM were screened for syphilis, indicating good provider adherence to this screening guideline. Low screening rates for gonorrhea and chlamydia, especially at rectal and pharyngeal sites, suggest that substantial barriers exist for complying with these guidelines," the authors concluded. "The moderate to high prevalence of asymptomatic chlamydial and gonococcal infections underscores the importance of screening. A range of clinical quality improvement interventions are needed to increase screening, including increasing the awareness of nucleic acid amplification tests for nonurethral screening."

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